best practice procedures - webstercare · best practice procedures ... packing and sealing the...
TRANSCRIPT
17-19 Moore Street, Leichhardt NSW 2040
P: +61 (0)2 9563 4900 I FREE CALL 1800 244 358
F: +61 (0)2 9563 4955 I FREE FAX 1800 626 739
EMAIL: [email protected] u
Best Practice ProceduresFOR PHARMACY AND RESIDENTIAL AGED CARE FACILITIES
© (03/2012) Manrex Pty Ltd t/as Webstercare -2012. Version 3.0S157
1
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
Portion-pak® Best Practice Procedures
Introduction ..................................................................... 2
Webstercare Aims .............................................................. 2
Essential Components For Portion-Pak .................................... 3
Pharmacy Section .............................................................. 9
Getting Started ................................................................. 9
Packing And Sealing The Portion-Pak ..................................... 11
The Final Check ............................................................... 15
Residential Aged Care Facility Section ................................... 19
Storage .......................................................................... 19
Medication Round ............................................................. 20
Communication ................................................................ 26
Quality Processes ............................................................. 29
Appendices ..................................................................... 32
2
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
Introduction Portion‐pak® has the advantages of Multi Dose, the safety of Unit Dose 7® colour coding, and the
convenience of Flexi‐pak® detachable doses.
How does it work? Portion‐pak comes in strips of seven for each dosage time. Prior to each medication round, nursing
staff remove each dose and place it in an administration tray to take on the medication round. At the
point of administration, the foil lid is peeled back, but remains on the blister. This means the
residents photo and all their medication information stays attached to the blister right up until it’s
administered. This reduces the risk of giving medication to the wrong person.
Multi-use packaging Portion‐pak has the largest blister capacity in the Webstercare® range. This allows nursing staff to
use the blister as a medication cup, crush the tablet in the blister and add puree to it if required.
Webstercare Aims Webstercare aims to:
Encourage a safe and responsible attitude towards use of medication
Minimise the likelihood of under‐use and over‐use of medication
Optimise the possible health outcomes through appropriate use of medication
Allow for easy monitoring of medication use by nursing staff
Supply of Portion‐pak is consistent with the concept of quality use of medicines for residential care
and supports facilities in safe and effective medication management as required in the accreditation
outcome 2.7. See Appendix 1 for an outline of the standards.
3
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
Essential Components for Portion-pak To supply and use Portion‐pak you will require the following materials;
1. Portion-pak Blisters The Portion‐pak blister consists of seven medication compartments, one for each day of the week. A
blister strip is required for each dosage time e.g. Breakfast, Lunch, Dinner and Bedtime. Each blister
strip is separated by a perforation that allows the individual doses to be detached.
There are two size blisters available, small and large.
2. Portion-pak Cold Seal Foil The Portion‐pak Foils are printed using a laser printer via
the Webstercare Medication Management Software
(MMS). Each sheet of foil consists of three portion‐pak
blister labels.
The Webstercare MMS prints the following features
onto the foil;
A barcode
Dosage time (also represented by a coloured
band)
Day and date the medication is to be
administered
Patient’s name and photograph (client photo)
Drug name, strength and dose
Room number
Pharmacy name and contact details
Doctor
Expiry Date
Small Portion‐pak Blister Large Portion‐pak Blister
Printed Portion‐pak Foil
4
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
3. Portion-pak Blu-Lok® Platen The Portion‐pak Blu‐Lok Platen accommodates one portion‐pak blister strip. The interlocking design
allows the user to join multiple platens together when packing. A minimum of four platens is
recommended.
4. Portion-pak Storage Tray
The storage tray holds the Portion‐pak blisters once prepared by the pharmacy, so they can be
securely transported to the facility. Storage trays are also stored at the facility in the medication
room before each dose is removed and placed in the administration tray ready each medication
round.
The storage trays are designed to stack on top of each other and can be stored in Portion‐pak
trolleys. An I.D insert which is printable using Webstercare’s MMS, can be placed in the storage tray
which allows you to distinguish one dosage time from the next.
Portion‐pak Blue‐Lok Platen
Multiple Interlocking Platens
Portion‐pak Storage Tray
5
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
5. Portion-pak Administration Tray
The blisters are placed into the Administration Tray prior to each medication round. The
administration trays are stored in the medication trolley for the duration of each round. The blisters
are held at a 30 degree angle to allow for easy identification.
6. Portion-pak Trolley
The Portion‐pak Trolley is used to store the administration and storage trays and any other items
needed during the medication round. The trolley has three small drawers that fit three
administration trays in each. One large drawer can store non packed and other items. The
Portion‐pak trolley also comes with a waste bucket and a holder for easy waste disposal.
Portion‐pak Administration Tray
Portion‐pak Trolley
6
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
7. Webstercare Medication Management Software
The Professional and Professional Plus versions of the Medication Management Software (MMS)
have the ability to print the Portion‐pak foils.
Special Medication Categories All PRN, Antibiotic and accountable medications should be packed be into either Webster‐pak or Unit Dose 7 Webstercard.
PRN (‘When Necessary’) Medication PRN medication is administered as required up to the prescribed limit and documented on the
medication chart or signing sheet.
A full pack is prepared (all blister compartments) with one PRN medication. Multiple folders may be
required until all medication is packed. For example: Panamax 500mg 100 tabs, 2 four times a day
PRN, would require 2 packs; one pack of 28 and one of 22.
PRN medications are identified by a white folder or ‘PRN’ labelling on the pack.
Multi Dose Unit Dose 7 Unit Dose 7 Webster‐pak Webstersystem Webstercard
7
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
Antibiotics Antibiotic medications are identified by a green folder or coloured band. Full quantities of antibiotics
or short term medications are packed into one or more packs with the dosage times set out by times
of the day and days of the week. Long‐Term Antibiotic medication is packed with regular
medications.
Accountable Medications e.g. S8’s Depending on the policies and procedures of an individual aged care facility, accountable
medications may be packed with regular medications or separately.
If packed separately, accountable drugs may be recorded and stored according to State regulations
(if required). Accountable medications are identified by a purple folder or coloured band.
Accountable medication that is prescribed as a PRN will be dispensed in the full quantity into one or
more packs. Purple folders with numbering from 28 (top‐left) to 1 (bottom‐right) are available. This
assists with accounting for the number of doses remaining.
Multi Dose Unit Dose 7 Unit Dose 7 Webster‐pak Webstersystem Webstercard
Multi Dose Unit Dose 7 Unit Dose 7
Webster‐pak Webstersystem Webstercard
8
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
Warfarin Medication
If required, Warfarin medication can be packed separately. Warfarin is identified by a mustard folder
or coloured band. The different coloured folder alerts staff this medication requires additional
attention. You may choose to store all Warfarin medication together at a particular dose time.
Medication ‘Not Suitable for Packing’ Medication unsuitable for repackaging can be dispensed in their original containers. The medication
chart and signing sheet serve as reminders for when non‐packed medication should be administered.
Alert cards should also be used in the medication chart folder as an extra reminder for nursing staff.
Examples of medicines unsuitable for packing include effervescent tablets, dispersible tablets, buccal
tablets, hygroscopic preparations and some solid dose cytotoxic preparations.
Webstercare can provide guidelines on medications not suitable for packing; however individual
circumstances and environmental issues will be taken into consideration by the servicing pharmacy.
Multi Dose Unit Dose 7 Unit Dose 7
Webster‐pak Webstersystem Webstercard
9
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
Pharmacy Section
Getting Started It’s very important to have complete and accurate resident profile information before you start to
package medication into Portion‐pak. To record this, use the Doctor Order/Patient Medication Profile
Form.
Exact dosage times and complete profiles of all medication must be recorded and maintained.
Multi Dose Checking Sheet
It is essential to check this information with the doctor or carer against written documentation
supplied by the doctor. You must then cross check this information against the prescriptions. You
may find discrepancies that will need to be discussed and resolved before commencing. At this time it
is opportune to check for any potential drug/drug or drug/disease allergies, interactions or dosage
discrepancies and take appropriate action.
The Multi Dose Checking Sheet can be printed through the reports section of the Webstercare MMS
(Medication Management Software). For further information refer to the MMS Quickstart Guide or
contact Software Support on 1300 132 466.
10
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
Patient Profiles The pharmacist must prepare accurate information on all medication and dosages. Doctor
Order/Patient Medication Profile Forms are completed from prescriptions or the medication chart. If
these details are different from other medication records, the pharmacist must verify this
information with the doctor, unless the doctor completed information.
The Doctor Order/Patient Medication Profile Form should be retained and used at all times as your
master copy record for each patient's individual medication profile. This is kept up to date at all times
and used for your final check against each finished pack. These profiles are best kept in a ring binder
or similar, preferably protected in a plastic sleeve.
All medication are to be listed on the Doctor Order/Patient Medication Profile Form, not only items
which are packed into the Portion‐pak, but also any other items, such as: liquids, eye drops,
ointments, patches, sprays and 'when necessary’ medication e.g. Analgesics or Sedatives.
Complying With PBS Requirements Medications are dispensed via the dispensing software in the usual way. Once the dispensing is
complete, a record of the dispensed medication for each patient must be maintained. This can be
done through the use of the MedsPro® using the Virtual Pill Count (VPC)™ system. A record of your
patient’s medications is retained in the software. If at any time a patient requests their medications,
you have a record of their balance held on their behalf and you can supply at short notice.
Alternatively, Integrity bags can be used to store each patient’s medications which are individually
labelled.
Non‐packed medication will be dispensed, labelled and supplied as normal e.g. Liquids, eye drops,
ointments, PRNs.
Complying with Guidelines Pharmacists should also refer to the “guidelines for medication management in residential aged care
facilities” released by the Australian Pharmaceutical Advisory Council (APAC). Other professional
guidelines such as QCPP and PSA should also be taken into consideration.
11
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
Packing and Sealing the Portion-pak
The Portion‐pak system is quick and simple to prepare. Refer to Appendix 2: Portion‐pak Packing
Procedures for a guide.
Preparation The Packing Technician:
Thoroughly washes hands prior to packing and uses gloves or Pil‐Kots™
Collects the first residents medication
Ensures there are plenty of supplies for packing
Places the medication for the first resident on their right. Once they have used the
medication, it is placed on their left hand side until packing is complete, speeding up the
workflow.
Workstation Set‐Up for Portion‐pak
Packing from Foil. Supplies within reach. Medication placed on one side prior to packing.
12
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
Step 1 Using the Webstercare MMS print the Portion‐pak foils through a laser printer. You can print per
individual resident or for a group of residents e.g. facility or section.
Step 2 Using the interlocking feature, lock four Portion‐pak Blu‐Lok platens into place. Select the
appropriate size blister for each meal time and place an empty blister sheet into each platen.
Step 3 Load medications into the blisters as per the medication profile printed on the Portion‐pak Cold Seal
Foil. Check for packing accuracy before sealing the blisters.
Interlocking Blu‐Lok Platens
Packing from Portion‐pak Foils
13
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
Step 4 Peel off one Portion‐pak Cold Seal Foil strip from the top right hand corner of each column. Align the
perforations on the foil with the perforations on the corresponding blister strip and carefully adhere
the foil to the blisters.
Step 5
Complete the sealing process by rubbing the palm of your hand across the blisters to maximise
contact between the foil and blister. The Pressure Roller can also be used to ensure a consistent,
secure seal.
Sealing blister with Portion‐pak Foil
Portion‐pak sealing
14
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
Step 6
Sign the ‘tech box’ on the last blister of each strip to verify you have packed accurately.
Step 7
Place the Portion‐pak strips into the Portion‐pak Storage Trays ready for checking by a Pharmacist. A
separate tray is used for each dosage time.
QA Sig Box signed by Packing Technician
Placing Portion‐pak Strips into the breakfast
storage tray ready for checking by a pharmacist
15
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
The Final Check
The minimum checking process recommended is a double cross check. Once the pack has been
prepared and checked by the packing technician, it must be cross‐checked and audited by a
Pharmacist.
Step 8
The Pharmacist checks the strips against the Multi Dose checking sheet with the original packs on
hand if required. It is best practice to check a resident’s entire profile at once. This way you get a
complete overview of the patient’s medication profile. Keep medication profiles well organised and
up to date in a folder. Always make sure there is enough information so that another Pharmacist can
easily prepare/check packs if the regular Pharmacist is not available. Changes can be communicated
directly by the Doctor and/or by means of a written prescription or by another written authorisation
such as evidence of a medication chart. Keeping this documentation on record ensures there is
always an audit trail of the communication process.
Checking Portion‐pak against the
Multi Dose Checking Sheet (hard copy record)
16
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
Step 9
The Pharmacist signs the ‘Pharm box’ to confirm a final audit has taken place and that they confirm
the packs to be correct.
Step 10 Place a ‘Facility ID Insert’ at the front of each storage tray or meal time ready for delivery to the Aged
Care Facility. Storage trays stack on top of each other to assist with transportation to the home.
Facility ID Labels can be reused from week to week. They should be replaced when details change or
they become worn.
Having the Prescriptions When Needed To comply with the PBS regulations you must ensure that prescriptions are available at the time of
dispensing. It is unacceptable and illegal for there to be any owing prescriptions unless in the case of
an emergency order from the doctor. When packing with the MedsPro system, you know exactly
how much medication is on hand at any time and when to request new prescriptions. Contact
Webstercare for further information.
QA Sig Box signed by Pharmacist
Storage trays with Facility ID Labels
17
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
Re-Ordering Medication The MedsPro system alerts you when it’s time to re‐order medication. Alternatively, re‐ordering
medication can be done using the blue Pharmacy Order and Thermal Re‐Order Labels. During the
packing process, if less than one‐week’s supply of a medication remains, remove the label’s lift‐off
tab and apply to the Order Sheet. Alternatively, orders can be handwritten onto the Order Sheet.
The Pharmacy Order Sheet can then be actioned by either dispensing medication from an existing
prescription or contacting the doctor informing them of the need for a new prescription.
Medication Changes Medication changes are common in an Aged Care Facility. There are a few scenarios in which a
medication change may occur;
1. New Medication: the new medication is supplied in a separate pack(s) containing enough
medication to last the remainder of the current weekly cycle. This means a blister strip may
contain empty blisters.
2. Dosage Increase: if possible the additional dose of medication is supplied in a separate pack/s
containing enough medication to last the remainder of the current weekly cycle. This means
a blister strip may contain empty blisters. You may choose to re‐supply the entire pack if
appropriate.
3. Dosage Decrease: the previous pack(s) must be returned to the pharmacy and a new pack
supplied with enough medication to last the remainder of the current weekly cycle. This
means a blister strip may contain empty blisters.
Thermal Re‐order Label applied to original box.
Re‐order section removed and placed on order sheet for dispensing.
18
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
4. Ceased Medication: the previous pack(s) must be returned to the pharmacy and a new pack
supplied with enough medication to last the remainder of the current weekly cycle. This
means a blister strip may contain empty blisters.
Pharmacy Support Your success with Portion‐pak depends on your understanding of the procedures involved. Please
contact us if you need further assistance or advice on Free Call 1800 244 358.
19
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
Residential Aged Care Facility Section
Storage
Prior to administration, Portion‐pak can be stored at the aged care facility in two ways depending on
the size of the facility/section.
1. In a locked medication room
2. In the locked Portion‐pak Trolley
In the medication room, the storage trays are stacked on top of each other. The trays slide in and out
like a drawer so you can easily access all Portion‐pak strips.
Storage trays can be placed in the drawers of the Portion‐pak trolley. Two storage trays will fit side
by side in each trolley drawer.
During the medication round, the Portion‐pak in the administration tray and other non‐packed
medications, are stored in the medication trolley drawers. Due to the compact nature of Portion‐pak,
limited storage is required in the medication room.
Storage Trays stacked and stored in the
medication room
20
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
Medication Round
Preparing for the Medication Round Nursing staff:
Remove the appropriate doses for the medication round from the Portion‐pak storage tray
and place them in the administration tray
Place other required items such as medication cups, jam etc. in the trolley
Select the Medication Charts for administration as well as the signing sheet or touchscreen
computer for signing
Removing dose from Portion‐pak strip Placing dose in administration tray
Trolley set‐up
21
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
Check for non‐packed, accountable medication or antibiotics to be administered during the
round
Take the trolley on the medication round
Administering Medication The Portion‐pak system supports facilities in safe and effective medication management as required
in the accreditation outcome 2.7. Refer to Appendix 3: Portion‐pak Administration Guidelines for a
summary of the following procedures.
Step 1
Place administration tray on the top of the trolley for the medication round.
Non‐packed and other items can be stored
in the bottom drawer of the trolley
Portion‐pak and Medication Charts/
Signing Sheets
22
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
Step 2 Identify the resident by name and photograph on the Portion‐pak dose, medication chart and/or
signing sheet or touchscreen PC.
Step 3 Peel back the Portion‐pak lid leaving the resident photo attached to the blister.
Peeling back the lidding leaving the
resident photo attached
23
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
Step 4 If required, crush the medication in the Portion‐pak blister. To avoid cross contamination, place a
medication cup within the Portion‐pak blister. Once crushed you can add appropriate mixer to the
blister.
Step 5 Give the Portion‐pak to the resident with a glass of water. Provide assistance where required. If the
medication has been crushed, remove the contents from the Portion‐pak with a spoon and
administer to the resident. Witness the resident swallowing the medication.
Step 6 Record administration on the medication chart, signing sheet or MedSig electronic signing program.
Step 7 Monitor the resident for any adverse reactions to the medication.
Crushing using the Rhino Crush.
Medication cup on top of medication avoids
contamination.
Mixer can be added into the
Portion‐pak blister
24
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
Resident not Present at Medication Round Nursing staff:
Leave the Portion‐pak blister in the administration tray
Continue with the medication round until all residents are completed
Return to administer the medication to the resident
If the resident is still not present, nursing staff note the reason code on the medication chart or
signing sheet and add any information to progress notes if required. Refer to Appendix 4: Exceptional
Circumstances Standard Operating Procedures for further information.
Resident Refusing Medications Nursing staff:
Temporarily reseal Portion‐pak or place removed medications into a Day Out
Clamshell‐pak labelled with the residents name and room number
Place the Day out Clamshell‐pak in the trolley drawer
Continue with the medication round as normal
Return to the resident and administer from the Day Out Clamshell‐pak
If they again refuse, mark the resident’s medication chart/signing sheet with
the appropriate reason code
Refer to Appendix 4: Exceptional Circumstances Standard Operating Procedures for further
information.
PRN (‘When Necessary’) Medication Nursing staff:
Locate the PRN medication folders
Select the required resident’s PRN medication folder
Identify the resident by name and photograph on the pack and
chart/signing sheet/touchscreen PC
Sign the PRN medication chart/signing sheet/touchscreen PC with
date, time, quantity and signature
Document details and outcomes in the residents progress notes as per facility policy and
procedures
25
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
Residents off Site/Social Leave To provide safe and effective medication management for residents who are off site, either on social
leave or on a day excursion/outing refer to the facility policy and procedures manual. For a guide to
handling off site medication administration refer to Appendix 5: Off Site Medication Administration
Standard Operating Procedure.
26
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
Communication It is important that good communication is maintained between the aged care facility and the
servicing pharmacy.
Re-ordering Medication The facility will not need to re‐order regular packed medication as this is part of the weekly packing
cycle. The pharmacy organises for the regular weekly medication to be delivered at an agreed time
each week.
For Non‐Packed or PRN Medication, it is important to have a process in place that all staff follow.
Staff members at the facility will either:
Order medication that is running low from the pharmacy through the MedsComm electronic
ordering system
Peel off the double ply re‐order label and place it on the green Pharmacy Order Sheet for
daily ordering through the pharmacy
Hand write an order on the Pharmacy order sheet
Medication Changes Medication changes are common in an Aged Care Facility. Medication changes must be
communicated to the pharmacy immediately to ensure pharmacy records can be kept up to date and
replacement/additional packs can be organised in a timely fashion. There are a few scenarios in
which a medication change may occur.
New Medication The new medication is supplied in a separate pack(s) containing enough medication to last the
remainder of the current weekly cycle. In this scenario there may only be enough packs for the
remainder of the week. For example, a weekly cycle starting Monday, a new medication is started
Wednesday, only packs from Wednesday to Sunday are supplied i.e. 5 days’ worth.
The Pharmacy will update their information to include the new medication with the next full week’s
medication.
This new medication can be labelled “additional” medication or similar to alert nursing staff if
required.
When the new order is written on the medication chart by the Doctor, nursing staff will:
1. Communicate the new order to the pharmacy using MedsComm or the Pharmacy Order
Sheet
27
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
2. Fax/scan to the pharmacy with a copy of the relevant medication chart and prescriptions if
required
When the new order is completed via telephone, nursing staff will:
1. Write the medication order onto the medication chart in the Telephone Orders section,
recording doctor, medication, dosage and date following facility policies and procedures
2. Communicate the new order to the pharmacy using MedsComm or the Pharmacy Order
Sheet
3. Fax/scan to the pharmacy with a copy of the relevant medication chart and prescriptions if
required
4. Pharmacist needs to clarify order with Doctor
When the new order is a faxed order, the staff at the aged care facility will:
1. Communicate the new order to the pharmacy using MedsComm or the Pharmacy Order
Sheet
2. Fax/scan to the pharmacy with a copy of the faxed medication chart and prescription
3. Attach the signed faxed copies to the medication chart for recording administration
Dose Changes Dosage Increase: where possible the additional dose of medication is supplied in a separate
pack(s) containing enough medication to last until the end of the current weekly cycle.
Dosage Decrease: the previous pack(s) must be returned to the pharmacy and a new pack
supplied with enough medication to last until the end of the current weekly cycle
Nursing staff will communicate dosage changes by:
1. Communicating the new order to the pharmacy using MedsComm or the Pharmacy Order
Sheet
2. Fax/scan the pharmacy a copy of the relevant medication chart and prescriptions if required
Ceased Medication and Dosage Changes
When a medication is ceased by the Doctor, the pack(s) must be returned to the pharmacy and a new
pack supplied with enough medication to last until the end of the current weekly cycle.
Nursing staff will communicate ceased medications by:
1. Communicating the ceased medication to the pharmacy using MedsComm or the Pharmacy
Order Sheet
2. Faxing to the pharmacy a copy of the relevant medication chart
28
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
Dropped or ‘Lost’ Medication Any medication that is accidentally lost or dropped can be replaced by administering last day of the
weekly cycle. This allows time for a replacement dose to be provided by the pharmacy in a labelled
vial or blister pack. This may be labelled “replacement” medication or similar.
Nursing staff should communicate dropped or lost medications to the pharmacy. The pharmacy will
always send new medication supplies at least 24 hours before the current supply runs out.
Administer the last dose from the pack checking that medication
and dosages are correct
Notify the pharmacy immediately
Pharmacy will supply an additional dose to ensure this later dose will not be missed
29
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
Quality Processes
Quality Assurance Quality Assurance (QA) audits are carried out regularly and a written report provided for review and
action. In particular QA audits address adherence to State and Commonwealth regulations, storage
and labelling of drugs, medication administration practices, adherence to these Best Practice
guidelines and any other matters specified by the drug committee.
Packaging Material Packaging material such as blisters and foil are disposable and must not be re‐used. Packaging
material with resident details must be discarded appropriately in a confidential waste bin.
Medication Advisory Committee (MAC) The purpose of a MAC is to determine policies and procedures to ensure optimal medication usage.
It is important that the supply pharmacist and medication review pharmacist are involved in the
Medication Advisory Committee (MAC).
Incident Reports Incident forms are used to aid the continuous improvement process. This form is ideal for reporting
medication incidents, causes and suggested short and long‐term corrective action. A quality
assurance checklist can be provided by Webstercare, to verify suggested processes are in place,
identifying room for improvement. This checklist has an incident report column where the need for
corrective action can be identified.
Involvement and response from the servicing pharmacy is an important part in continuous
improvement.
Equipment Both the aged care facility and the servicing pharmacy are responsible for ensuring all equipment
and consumables used in the medication administration process are fit for the purpose as supplied
by Webstercare.
30
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
Disposal of Drugs Any unused, discontinued or out of date medication is removed and disposed of in accordance with
State and Commonwealth regulations and in an environmentally safe manner. Medication
discontinued for a resident is kept for a short period of time in case it is recommenced (for example,
one week) and then disposed of. Medication prescribed and supplied for one resident is NOT to be
used for another.
Deliveries and After Hours Service The majority of routine orders are delivered on a weekly basis at a time agreed or at a frequency
decided by both parties. Depending on the contract between the pharmacy and the aged care
facility, the pharmacy may provide a daily service for urgent items, new items and new residents as
well as general stock. Typically an emergency number is available for after hour’s emergencies.
Emergency Supply As Doctors may initiate treatment when the pharmacist is unavailable, a list
of emergency items is determined by the prescribing preferences of the
visiting doctors in accordance with State and Commonwealth Regulations,
and through the Medication Advisory Committee (MAC) of the Aged Care
Facility.
A supply of emergency medication is kept, where allowable, in an emergency
supply box or similar. Emergency supply medication is to be kept in original
manufacturer's bottles and packs and administered only on the
authorisation of a medical practitioner.
Procedures for STAT Medication at the aged care facility:
1. Identify the medication that you require
2. Remove from STAT box
3. Determine what you need to do with the medication (e.g. liquids)
4. If needing only one or two doses of an emergency supply medication (tabs / caps),
administer only the doses required until the resident’s pack arrives
5. Return balance of medication to the emergency supply box
When emergency stock is used, the pharmacy must be informed so that it can be replaced. The
emergency stock packs carry the re‐order label and are labelled ’emergency supply’ or as stock.
Emergency Supply Box
31
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
Education In‐service education should be provided to all staff on implementation of the system. The
pharmacist accompanies the nursing staff on the initial medication rounds to support staff becoming
familiar with the systems and procedures. Regular in‐service is provided to staff on the policies and
procedures involved in the smooth operation of the system.
General pharmaceutical education is provided on a regular basis and the Webstercare Continuing
Education Newsletter is provided monthly to all nursing staff. The Webstercare website
(www.webstercare.com.au) holds a library of past continuing education documents distributed over
several years.
32
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
Appendices
Appendix 1: Aged Care Standards and Accreditation Agency - Expected Outcome 2.7 Medication Management
33
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
Appendix 2: Portion-pak Pharmacy Packing Procedures
34
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
Appendix 3: Portion-pak Administration Guide
35
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
Appendix 4: Exceptional Circumstances Standard Operating Procedures
Please see over page.
March 2012 Version: 002 Page 1 of 3
Purpose The aim of this procedure is to provide directions to ensure safe and effective management of medications when exceptional circumstances occur during a routine medication round, such as:
Resident is temporarily absent during a medication round Medication cannot be administered due to unsuitable environment Resident chooses not to take the medication There are discrepancies between the medication, the medication chart and /or signing sheet Medication is withheld as per Doctors instructions
Policy Statement It may not be possible initially to administer all medications during a routine medication round and exceptions will occur; for example, a resident may choose to refuse medications or may be temporarily absent. The aim of this policy is to ensure that when exceptional circumstances occur, resident’s medications are managed safely and effectively. Definitions
RACF - Residential aged care facility DAA - Dose administration aid PMC – Primary Medication Chart DOCP – Day Out Clamshell-Pak Packed medications – Medications that have been dispensed by a pharmacist, packed into a
Webster-pak DAA and labelled for an individual resident Staff member - RACF staff member who meets the scope guidelines for medication administration.
Scope The provision of safe and effective medication administration for residents during routine medication rounds is undertaken by a Registered Nurse, Endorsed Enrolled Nurse, or Care Worker who has the knowledge, skills and competence to administer medications and is authorised by the facility to undertake such a role. Procedure It is intended that this policy is customised and used in conjunction with the facilities medication policies and procedures and that administration staff are familiar with relevant policies.
1. Select the pack(s) for the medication round time and place on trolley. The visual colour cue on the Webster-pak should correspond to the correct dose administration time e.g. pink = breakfast. If unsure check against a Folder Colour Code card. Select the Primary Medication Chart (PMC) and signing sheets if not using MedSig electronic signing. Check you have everything you need for administration before starting medication round.
Standard Operating Policy and Procedure:
Exceptional circumstances during a routine medication round
March 2012 Version: 002 Page 2 of 3
2. Identify the right resident by using resident’s name and colour photograph on the Webster-pak, primary medication chart and signing sheet / electronic signing option. Check the Webster-pak and non-packed medications against the primary medication chart and signing sheet. If you find any discrepancies, do not administer the medications. Advise your supervisor and they will clarify the medication order. If needed, they will contact the pharmacy or GP for more information. Administer medications only after discrepancies have been clarified.
3. Check the environment is suitable for the type of medication that is to be administered. Factors to consider are:
• resident’s right to privacy • infection control • Specific equipment needed for medication administration
If the environment is not suitable then do not administer the medications. Place a plastic alert card (see below) either next to the Webster-pak or next to the signing sheet. If using MedSig electronic signing use the exception code E (end of round). Continue to the next resident.
Unit Dose 7 Alert Card
4. Check to see if the resident is available and ready to take their medications
If the resident is temporarily unavailable, place a plastic alert card (see above) next to the Webster-pak or next to the medication signing sheet in the medication chart folder. Do not remove medications from the blister at this stage. If using MedSig electronic signing use the exception code E (administer at end of medication round). Continue to the next resident.
5. After locating resident, verbally confirm their ID and ask if they are ready to take their medications. If the resident chooses not to take their medications at this time, place a plastic alert card (see above) next to the Webster-pak or next to the medication signing sheet in the medication chart folder. Do not remove medications from the blister at this stage. If using MedSig electronic signing use the exception code E (administer at end of medication round). Continue to the next resident.
6. After confirming the resident is ready to take their medications remove the contents of the Webster-pak using a Pil-Bob or medication cup. Check all tablets / capsules have been removed for
March 2012 Version: 002 Page 3 of 3
that dosage time and check against the number of tablets in the cup. Check for other medication packs such as antibiotics and non-packed medications. Administer medications to resident with a glass of water and offer assistance as needed. Witness the resident swallowing the medication. Sign in the right date and dose box on the signing sheets or MedSig electronic signing after administration is complete. If the resident chooses not to take one or all of their medications after they have been removed from the blister, place the loose medications into the appropriate dose time blister of a Day Out Clamshell-pak (DOCP). The DOCP is colour coded to identify Breakfast, lunch, dinner and bedtime doses. Label the DOCP with the resident’s name and leave on the trolley until the end of the medication round.
7. After administration to each resident, locate each resident with missed medication by using the plastic alert cards. Administer the medications following facility procedure for medication administration. Sign in the right date and dosage box on the signing sheet. Reapproach residents who have previously chosen not to take their medications. If the resident chooses not to take these medications at the end of the medication round, dispose of the medication/s appropriately following facility policies. Use the appropriate exception code as needed e.g. R for refused, in the right date and dosage time box on the signing sheet and document in progress notes according to facility policies.
Related Documents Medication administration policy Disposal of medication policy High risk medication policy Off site medication administration policy
Legislation
Aged Care Act 1997 Quality of Care Principles 1997, Schedule 2: Accreditation Standards User Rights Principles: Schedule 1 Charter of residents’ rights and responsibilities
References
APAC Guidelines for Medication Management in Residential Aged Care Facilities
Webstercare Best Practice Policies and Procedures
© Manrex Pty Ltd t/as Webstercare – 2012
17-19 Moore St Leichhardt NSW 2040
Ph (02) 9563 4900 ● Free Call 1800 244 358
Fax (02) 9563 4955 ● Free Fax 1800 626 739
www.webstercare.com.au ● [email protected] Webster-pak, MedSig is a Registered Trade Mark of Manrex Pty Ltd t/as Webstercare whilst Clamshell-pak is a Trade Mark of
Manrex Pty Ltd t/as Webstercare.
This Standard Operating Procedure is provided as a guide only and should be customised to suit
individual facility policy and procedures.
36
Best Practice Procedures for Portion-pak®
© (2009) Manrex Pty Ltd (ABN: 63 074 388 088) t/as Webstercare – 2011
Appendix 5: Off Site Medication Administration Standard Operating Procedure
Please see over page.
April 2011 Version: 001 Page 1 of 6
Purpose To provide direction for the provision of safe and effective management of medication for residents who are off site, either on social leave or on a day excursion/outing. Policy Statement All residents who are off site for a medication dosage time/s are provided with their medication/s to support ongoing optimal drug therapy. Definitions
RACF ‐ Residential Aged Care Facility DAA – Dose Administration Aid DOCP ‐ Day Out Clamshell‐Pak Packed medications – medications that have been dispensed by a pharmacist into a Webster‐pak DAA
and labelled for an individual resident. Scope The provision of safe and effective medication administration for residents that are off site is undertaken by a Registered Nurse, Enrolled Nurse or Care Worker who has the knowledge, skills and competence to administer medications and authorised by the facility to undertake such a role. Procedure 1. Determine who the medications will be provided to e.g. resident or their representative. Factors to
consider include: Resident’s rights Resident’s cognitive ability Resident’s physical ability Resident currently self administering
If the resident is not currently self administering confirm the willingness of their representative to take responsibility for medication administration.
2. Determine the number of medication dosage times that the resident will be off site.
3. Confirm the right resident is selected Select the right medication chart Cross check the resident medication chart with the Webster‐pak
o Confirm resident identity using the photo and demographic details on both the medication chart and the Webster‐pak
4. Determine the types of medications that the resident will need during their absence from the RACF e.g. packed, unpacked medications such as eye drops, ointments, creams, inhalants, insulin, patches, injection etc
Standard Operating Policy and Procedure:
Off Site Medication Administration
April 2011 Version: 001 Page 2 of 6
5. Identify the most suitable tool/s to be used to ensure the appropriate administration of packed
medications. Consider factors such as: Need for medications to be secure Need for easy to open pack Need for easily portable and/or compact pack and maintain integrity of medications Easy to determine which medications are to be taken and at which time/s of the day Whether the Webster‐pak DAA has the capacity to remove one or more administration
compartments e.g. Webster‐pak Flexi‐pak (Multi dose)
6. Resident Off Site for less than 24 hours (see flowchart below) Select the correct resident Webster‐pak/s for the dosage times that the resident will be off site. Check also for other Webster‐paks e.g. antibiotics, warfarin, Schedule 8, cytotoxics etc and non‐packed medications. Collect a Webstercare Day Out Clamshell‐pak. The DOCP is colour coded to identify breakfast, lunch, dinner and bedtime doses and contains enough medication for one day. It negates the need for the resident to take their whole Webster‐pak with them and provides a secure way of storing medication. Using the DOCP, the resident can take the medication dosage times they need and leave the remainder of the medication securely within their Webster‐pak. When using a DOCP it is essential that a resident identification label or the resident’s name and phone number be written on the box. It is important that the medications ordered are NOT transcribed on to the DOCP. Once the DOCP is labelled correctly, confirm the right resident’s medication chart and Webster‐pak/s has been selected. Confirm that the medications to be placed into the DOCP are as prescribed. Remove the medications from the Webster‐pak DAA and place them into the corresponding colour coded sections of the DOCP. For example, the lunch time medications into the yellow DOCP compartment. Non Packed All non‐packed medications should be provided to the resident / representative in a sealed bag/container. Each non‐packed item should be checked to confirm that they have the pharmacy dispensing label which includes the resident name, drug, strength and route of administration. Once medications are removed from the Webster‐pak and placed in DOCP and non packed medications prepared, enter the O code for Outing (Medication with Resident) or L for Social Leave, for each medication on the medication signing sheet or in MedSig.
April 2011 Version: 001 Page 3 of 6
Flowchart: Resident Off Site for less than 24 hours
•Determine who the medications will be provided to
•Identify the number of medication dosage times that the resident will be off site
•Confirm the right resident by selecting the right medication chart, Webster‐paks and non‐packed items
•Select and label the DOCP with resident name and contact number
•Remove the medications from the Webster‐pak and place in the DOCP
•Place non‐packed items in sealed bag/container
•Document an O or L code on medication signing sheet or MedSig
•Provide an explanation to resident / representative
•Provide resident / representative with a copy of the current medication chart
•Document in progress notes
•Document outcome upon return
April 2011 Version: 001 Page 4 of 6
7. Resident Off Site for more than 24 Hours (see flowchart below) Select the correct resident Webster‐paks/s for the dosage times that the resident will be off site. Check also for other Webster‐paks e.g. antibiotics, warfarin, Schedule 8, cytotoxics etc. Medications are to remain in the Webster‐pak DAA.
In instances where the resident will be away for a period longer than the Webster‐pak DAA provides for contact the supply pharmacist to arrange for the required dosages to be provided in a Webster‐pak suitable to the needs of the resident and/or their representative e.g. Multi Dose Webster‐pak. The pharmacist should be contacted at least 48 hours prior. Non Packed All non‐packed medications should be provided to the resident / representative in a sealed bag/container. Each non‐packed item should be checked to confirm that they have the pharmacy dispensing label which includes the resident name, drug, strength and route of administration.
8. Provide an explanation to resident/representative. This should include the following: Correct time , dose and route for all medications that need to be administered, including packed
and non packed medications Special requirements for any prescribed medications e.g. take medication ½ hour prior to meal,
place patch on in the AM and remove in the PM What to do in the instance they are uncertain e.g. Call the RACF and speak with the person in‐
charge or the pharmacy Appropriate storage of packed and non packed medications Correct technique for administration of medications.
9. Provide the resident/representative with a copy of the current medication chart if appropriate.
10. Document the arrangements for administration of medication whilst a resident is off site in the
resident’s progress notes. Documentation should include: Who the medications were given to e.g. resident or their representative The types of medications provided e.g. packed, non packed The information that was provided to the resident/representative e.g. storage in a cool dry place,
contact the RACF or pharmacy if they are uncertain Dates and/or time that the resident will be off site On the record of medication administration enter the O code for Outing (Medication with Resident) or L for Social Leave, to indicate that the resident is on leave.
11. Monitoring/Return Onsite When the resident returns from their outing or social leave confirm that the medication administration occurred by checking the DOCP or Webster‐pak DAA. If there is any discrepancy noted in the pack complete an incident form and document in the resident progress notes.
April 2011 Version: 001 Page 5 of 6
Flowchart: Resident Off Site for more than 24 hours
•Determine who the medications will be provided to
•Identify the number of medication dosage times that the resident will be off site
•Confirm the right resident by selecting the right medication chart, Webster‐paks and non‐packed items
•Place non‐packed items in sealed bag/container
•Document an O or L code on the medication signing sheet or MedSig
•Provide an explanation to resident/representative
•Provide resident/representative with a copy of the current medication chart
•Document in progress notes
•Document outcome upon return
April 2011 Version: 001 Page 6 of 6
Legislation
Aged Care Act 1997 Quality of Care Principles 1997, Schedule 2: Accreditation Standards User Rights Principles: Schedule 1 Charter of residents’ rights and responsibilities
References
APAC Guidelines for Medication Management in Residential Aged Care Facilities Resource Kit to enable implementation of the APAC Guidelines for Medication Management in
Residential Aged Care Facilities ‐ http://www.health.vic.gov.au/dpu/resource‐kit.htm
© Manrex Pty Ltd t/as Webstercare – 2011
17‐19 Moore St Leichhardt NSW 2040
Ph (02) 9563 4900 ● Free Call 1800 244 358
Fax (02) 9563 4955 ● Free Fax 1800 626 739
www.webstercare.com.au ● [email protected]
Webster‐pak is a Registered Trademark of Manrex Pty Ltd t/as Webstercare. Clamshell‐pak is a Trademark of Manrex Pty Ltd t/as Webstercare.
This Standard Operating Procedure is provided as a guide only and should be customised to suit
individual facility policy and procedures.